David L. Bell

Lower peak bone mass and abnormal trabecular and cortical microarchitecture in young men infected with HIV early in life.

Introduction:HIV infection and antiretroviral therapy (ART) early in life may interfere with acquisition of peak bone mass, thereby increasing fracture risk in adulthood. Methods:We conducted a cross-sectional study of dual-energy X-ray absorptiometry (DXA) and high-resolution peripheral quantitative computed tomography (HR-pQCT) in 30 HIV-infected African–American or Hispanic Tanner stage 5 men aged 20–25 on ART (15 perinatally infected and 15 infected during adolescence) and 15 HIV-uninfected controls. Results:HIV-infected men were similar in age and BMI, but were more likely to be African–American (P = 0.01) than uninfected men. DXA-derived areal bone mineral density (aBMD) Z-scores were 0.4–1.2 lower in HIV-infected men at the spine, hip, and radius (all P < 0.05). At the radius and tibia, total and trabecular volumetric BMD (vBMD), and cortical and trabecular thickness were between 6 and 19% lower in HIV-infected than uninfected men (P <0.05). HIV-infected men had dramatic deficiencies in plate-related parameters by individual trabeculae segmentation (ITS) analyses and 14–17% lower bone stiffness by finite element analysis. Differences in most HR-pQCT parameters remained significant after adjustment for race/ethnicity. No DXA or HR-pQCT parameters differed between men infected perinatally or during adolescence. Conclusion:At an age by which young men have typically acquired peak bone mass, HIV-infected men on ART have lower BMD, markedly abnormal trabecular plate and cortical microarchitecture, and decreased whole bone stiffness, whether infected perinatally or during adolescence. Reduced bone strength in young adults infected with HIV early in life may place them at higher risk for fractures as they age.

Adolescent and Young Adult Male Health: A Review

Adolescent and young adult male health receives little attention, despite the potential for positive effects on adult quality and length of life and reduction of health disparities and social inequalities. Pediatric providers, as the medical home for adolescents, are well positioned to address young men’s health needs. This review has 2 primary objectives. The first is to review the literature on young men’s health, focusing on morbidity and mortality in key areas of health and well-being. The second is to provide a clinically relevant review of the best practices in young men’s health. This review covers male health issues related to health care access and the Centers for Disease Control and Prevention’s Healthy 2020 objectives for adolescents and young adults, focusing on the objectives for chronic illness, mortality, unintentional injury and violence, mental health and substance use, and reproductive and sexual health. We focus, in particular, on gender-specific issues, particularly in reproductive and sexual health. The review provides recommendations for the overall care of adolescent and young adult males.

Creating Teachable Moments: A Clinic-Based Intervention to Improve Young Men's Sexual Health

A multicomponent health education intervention for men was integrated into initial visits at the Young Men’s Clinic in New York City. In all, 157 predominantly low-income, Latino and African American patients completed pre- and post-test surveys to assess their sexual and reproductive health knowledge, beliefs, attitudes, and behaviors. Paired t tests compared respondents’ scores on outcome variables at baseline and follow-up. Intervention participants significantly increased their knowledge (e.g., emergency contraception) and frequency of safer sexual behaviors (e.g., condom use) during the 3 months following their initial visit. The intervention was not as successful promoting positive beliefs about health care utilization or attitudes about condoms. Participants reported high levels of satisfaction with the intervention. This study provides evidence that it is feasible to effectively disseminate sexual health information to men at each step of a routine clinic visit, including down time in waiting rooms and individual encounters with health educators and medical providers.

Relationship Violence, Fear, and Exposure to Youth Violence Among Adolescents in New York City

Previous research has shown that there is an overlap between experiences of youth violence and adolescent relationship violence. Yet, little research exists which investigates the sex differences in the associations between specific types of youth violence and relationship violence while controlling for potential confounders. This study addresses this gap in the literature by exploring the associations between experiences of youth violence and receiving and delivering relationship violence in an urban adolescent sample. From 2006 to 2007, 1,454 adolescents aged 13 to 21 years in New York City completed an anonymous survey that included the validated Conflict in Adolescent Relationships Inventory that estimates experiences of relationship violence in the previous year as well as the prevalence of various exposures to youth violence. Bivariate and multivariate analyses assessed the overlap between experiencing other types of youth violence and delivering and receiving physical relationship violence and sexual coercion. Compared with youth in nonviolent relationships, we found a significant association between delivering and receiving relationship physical violence and sexual coercion with participating in a fight, missing school due to fear, being threatened/injured with a weapon, gang membership, and carrying a weapon among both males and females. We also identified the sex differences between these specific associations of youth and relationship violence. Service providers working with adolescents experiencing relationship violence should be aware that they face a higher concurrent risk of experiencing or participating in other forms of youth violence. Likewise, providers working in the area of youth violence intervention and prevention should consider the possibility of concurrent relationship violence. Based on these findings, further research should explore whether interventions targeting relationship violence can also impact participation in youth violence and vice versa.

Connecting the adolescent male with health care.

Starting in adolescence males use health care services less than females. Younger adolescent males who use existing services rely on access to their primary clinician: pediatricians adolescent medicine physicians family physicians internists or nurse practitioners. Older adolescent and young adult males obtain medical care from hospital emergency departments more often than primary care clinicians. Many adolescent males who do have contact with clinicians receive limited medical examinations whether for injuries or for sports physicals. There are few opportunities for preventive health messages or discussions with male adolescents; only one third report talking with a clinician about a reproductive health topic. Unfortunately utilization of health services decreases further as males leave high school and become increasingly disconnected from traditional venues that provide preventive health care services and education to young people. (excerpt)

Male access to emergency contraception in pharmacies: a mystery shopper survey

BACKGROUND Pharmacy access to emergency contraception (EC) could involve men in pregnancy prevention. The objectives were to assess the availability and cost of EC. STUDY DESIGN Male mystery shoppers visited 158 pharmacies in three neighborhoods in New York City. They asked for EC and its cost and noted weekend hours. RESULTS Twenty-two (73.3%) of 30 pharmacies created barriers to get EC. The cost of EC was higher in the higher-socioeconomic status (SES) neighborhood (p<.001), and the higher-SES neighborhood pharmacies had a greater number of weekend hours (p<.001). CONCLUSIONS Overall, males had a 20% probability of not being able to access EC. The national dialogue should include males.

Men’s Preferences for Sexually Transmitted Infection Care Services in a Low-Income Community Clinic Setting in New York City

A self-administered anonymous waiting room survey was used to evaluate men’s preferences on testing, notification, and treatment for sexually transmitted infections (STIs) in a community clinic in Upper Manhattan in 2007. Sixty-seven percent of eligible men (n = 199) participated. Most were willing to collect a urine sample at home (71%, n = 140) or at the clinic (87%, n = 171). Respondents preferred learning of a positive STI test result by phone (67%, n = 123). However, men were willing to receive results by text (65%, n = 127) or e-mail (61%, n = 121). Most (83%, n = 162) reported they would be (very) likely to take STI medication brought to them by a partner. Twenty-one percent reported previous gonorrhea or Chlamydia infection (n = 41). Of these, 39% (n = 16) had received medication to bring their partner, and almost all (n = 14/16) reported their partner took the medicine. Multiple options for STI testing, notification, and treatment are recommended to maximize service use among men, including providing patient-delivered partner therapy.

The male genital examination: a position paper of the Society for Adolescent Health and Medicine.

The male genital examination is a simple and quick clinical assessment and is important for screening and diagnostic purposes beyond the need to screen for testicular cancer. Despite the lack of evidence supporting screening for testicular cancer, the genital examination should be included as part of a males routine physical examination, as well as when a male patient presents with genital complaints.

Adolescent boys' experiences of first sex

There are limited contextual data regarding first sexual experiences of younger adolescent men. Yet these data that are needed to inform sexually-transmitted-infection and early-fatherhood-prevention efforts, particularly in lower-income communities. Using qualitative methods, 14 adolescent men (ages 14–16, all low-income, most African American) from a mid-sized US city were asked about relationships and sexual experiences in a one-hour face-to-face semi-structured interview, with two follow-up interviews at six- to nine-month intervals. Story-telling was encouraged. Descriptions of first sex were identified and then analysed for narrative structure and shared concepts. The dominant narrative of first sex proceeded through three steps: (1) preparation, which involved identification of a sexualised space, mentoring and pre-planning, (2) the event, which involved looking for cues indicating sexual interest and consent from a female partner, feelings of fear/nervousness and first sex itself and (3) afterwards, which involved a return to prior activities, minimal verbal exchange and a general positive feeling, sometimes accompanied by later disappointment. Mentorship, initiation by the female and idealising sex as a romantic experience, played important roles in constructing the context of first sex. These factors should be incorporated in harm-reduction interventions for young men in similar contexts.

Adolescent male sexuality.

Adolescence is a transition period between childhood and adulthood. During this time the body develops into an adult and reproductively mature body. For many adolescents it is the time of completion of high school finding first jobs leaving home and beginning college. It is a stage to discover and establish an identity independent of the family. It is a time of exploration of romantic relationships including the initiation of sexual relations. All adolescents are sexual beings whether they are sexually active or not. Adolescents are often sexually active—a fact supported by data from many developed countries. Most adolescent males have their first sexual experience during their teenage years. Health care providers are not always comfortable addressing their sexual activity however. Only one third of adolescent males report talking with their clinician about a reproductive health topic. It is essential for health care providers caring for adolescents to understand male sexuality during the teenage period. This article provides an overview of heterosexual adolescent male sexuality. Another article in this issue gives an overview of gay bisexual and questioning youth. (authors)